Towner County Living Ctr

Based on observation, review of facility policy, review of resident council minutes, review of the facility assessment, review of the dietary schedule, and staff interview, the facility failed to ensure sufficient staff for meal service in 1 of 1 dining room. Failure to serve resident meals in a timely manner did not enhance the dining experience for the facility's residents.Findings include:Review of facility policy titled Nutrition Services Staffing occurred on 01/14/26. This policy, revised 04/08/25, stated, . The department will be staffed adequately to meet the patient's nutritional needs with regular meals served to patient at 7:30am [morning], 11:45am and 5:30pm [evening]. The facility will provide sufficient support personnel to safely and effectively carry out the supportive functions of the Food and Nutrition Services. These functions include, but are not limited to: . Safe and timely meal preparation . Providing meals and/or supplements in accordance with residents' needs . Review of the resident council minutes occurred on all days of survey and showed the following:*…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, review of resident council meeting minutes, review of facility policy, and resident and staff interviews, the facility failed to take actions aimed at performance improvement and, after implementing those actions, measure its success, and track performance to ensure that improvements are identified and sustained. Failure to perform Quality Assurance and Performance Improvement Program (QAPI) for continued resident concerns placed all residents at risk for not having their needs met. Findings includeReview of policy, Quality Assurance & Performance Improvement Program occurred on 01/14/26. This undated policy stated, . the scope of the QAPI program encompasses all segments of TLCL ([NAME] County Living Center) including resident . feedback . Our organization will conduct Performance Improvement Projects [PIP] that are designed to take systemic approach to revise and improve care or services in the areas that we identify as needing attention. We will conduct PIPs (performance improvement…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on review of the facility reported incident (FRI) investigation, record review, review of facility policy, and staff and resident interviews, the facility failed to ensure each resident received adequate supervision to prevent accidents for 1 of 1 sampled resident (Resident #4) investigated for a fall. Failure to ensure staff provided hands on assistance with ambulation resulted in a fall with injury to Resident #4 and has the potential for all residents who require hands on assistance with ambulation to experience falls and/or injury.Findings includeReview of the facility policy titled Fall Prevention Policy occurred on 01/14/26. This policy, dated 10/03/24, stated, . Each resident will be assessed for fall risk and will receive care and services in accordance with their individualized level of risk to minimize the likelihood of falls.Review of the FRI investigation, received from the facility on 03/19/25, stated, . RN [registered nurse] [#9] verbally reported CNA [#8] called her into the room and when she came in found [Resident 4] on the floor with a quarter size open flap…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, review of facility policies, and staff interview, the facility failed to ensure food is stored in accordance with professional standards for food service sanitation in 1 of 1 kitchen. Failure to ensure food is stored, prepared and served in a sanitary environment, and to ensure sanitary strips are not expired, may result in contamination of foods and foodborne illness. Findings include:Review of the facility policy titled Food Storage occurred on 01/14/26. This policy dated September 2010, stated, . The store room will be clean . Items stored under refrigeration that are ready to eat and potentially hazardous shall be marked with date prepared. Potentially hazardous [foods] like meats, spreads and salads will be kept for three days after date prepared . Other less hazardous foods like gelatin and canned fruit will be kept five days after date opened. Food must be stored sufficiently above floor level . 6-12 off the floor . Lighting, ventilation and humidity should be controlled to meet requirements and prevent both condensation and the growth of microorganisms.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review, review of facility policy, and staff interview, the facility failed to follow standards of infection control and prevention for 1 of 1 sampled resident (Resident #3) observed during cares. Failure to apply appropriate personal protective equipment (PPE) when providing care to residents in enhanced barrier precautions (EBP) has the potential to spread infection to residents, staff and visitors. Findings include: Review of the facility policy titled, Infection Control-Enhanced Based Precautions occurred on 01/14/25. This policy, revised September 2025, stated, . Enhanced Barrier Precautions require the use of gowns and gloves . For residents for whom enhanced Barrier Precautions are indicated, Enhanced barrier Precautions is employed the preforming resident care activities: . Transferring. Changing briefs or assisting with toileting . Review of Resident #3's medical record occurred on all days of survey. A physician's order dated, 06/26/24, stated Enhanced Barrier Precautions due to indwelling catheter - G-Tube [feeding tube] Observation on…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, review of facility policy, and resident and staff interviews, the facility failed to serve beverages at palatable temperatures in 1 of 2 meals observed. Failure to serve foods at palatable temperatures to residents may result in decreased intake, weight loss, and inadequate nutrition. Findings include: Review of the facility policy titled Food Storage occurred on 09/24/24. This undated policy, stated, .Purpose: to store food under sanitary conditions to protect it from contamination and outdating . 11. dairy products . must be stored at temperatures between 33-40 degrees Fahrenheit . During an interview on 09/23/24 at 2:15 p.m., Resident A stated, The cold drinks are warm. Observation of the breakfast meal occurred on 09/24/24 at 8:38 a.m. showed staff served residents their milk from three half gallon cartons sitting in a pan of water. Temperatures obtained showed the following: * Whole milk at 50 degrees Fahrenheit * 2% milk at 49 degrees Fahrenheit * Chocolate milk at 60 degrees Fahrenheit During an interview on 09/24/24 at 08:56 a.m., a dietary staff (#3)…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review, review of facility policy, and staff interview, the facility failed to ensure accurate labeling of medications for 1 of 2 sampled residents (Resident #22) with a gastrostomy tube (G-tube)observed during medication pass. Failure to ensure appropriate labeling of medications placed residents at risk for medication errors and/or injury. Findings include: Review of the facility policy titled Labeling of Medications occurred on 09/24/24. This policy, dated July 2024, stated, . 1. All medications will be labeled in accordance with applicable federal and state requirements and current accepted pharmaceutical principals and practices . 2. Labels for individual drug containers must include: . i. The route of administration . 10. The pharmacy must be informed of any order changes or changes in directions for the use of the medications . - Review of Resident #22's medical record occurred on all days of survey and included a physician's order to administer medications via G-tube. - Observation during medication pass on 09/24/24 at 2:49 p.m. showed a staff…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review, review of facility policy, and staff interview, the facility failed to ensure the consultant pharmacist completed and reported the drug regimen reviews at least monthly for 5 of 5 sampled residents (Resident #2, #5, #6, #7, and #16) selected for unnecessary medication review. Failure to complete and report drug regimen reviews may result in residents receiving unnecessary medications and experiencing adverse consequences related to the medications. Findings include: Review of the facility policy titled Pharmacy Monthly Medication Review of LTC [Long Term Care] Residents occurred on 09/07/23. This undated policy, stated, . Review new orders since the last month's review. Scan medication profile/Physician Order Sheet for compliance with the DRUG REGIMEN REVIEW GUIDELINES (DRR). Review of Residents #2, #5, #6, #7, and #16's medical records occurred on all days of survey. The record identified the most recent drug regimen reviews dated as follows: * Resident #2 - 05/31/23 * Resident #5 - 03/31/23 * Resident #6 - 04/30/23 * Resident #7 - 03/31/23 * Resident #16 -…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review, review of the North Dakota Provider Manual for Preadmission Screening and Resident Review (PASRR) and Level of Care Screening Procedures for Long Term Care Services, and staff interview, the facility failed to complete a status change assessment for 1 of 1 sampled resident (Resident #7) reviewed for PASRR. Failure to complete a change in status assessment with a newly diagnosed mental illness and/or change in treatment may result in the delivery of care and services that are inconsistent with residents' needs. Findings include: The North Dakota PASRR Provider Manual, revised December 2020, page 13, states, . Change in Status Process: Whenever the following events occur, nursing facility staff must contact [the contracted agency] to update the Level I screen for determination of whether a first time or updated Level II evaluation must be performed. These situations suggest that a significant change in status has occurred: . If an individual with MI, ID, and/or RC [mental illness, intellectual disability, and conditions related to intellectual disability…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, review of facility policy, and staff interview, the facility failed to review and revise the comprehensive care plan to reflect the current status for 1 of 12 sampled residents (Resident #4). Failure to review and revise the care plan limited staffs' ability to communicate needs and ensure continuity of care. Findings include: Review of the facility policy titled Resident Care Plan occurred on 09/07/23. This policy, dated 08/16/18, stated, . the care plan will include measurable objectives and timetables to meet a resident's medical, nursing, and psychological needs as identified by the comprehensive assessment. The comprehensive care plan will be reviewed and revised by the Interdisciplinary Team on a quarterly basis at minimum and on an ongoing basis to reflect changes in resident status. Review of Resident #4's medical record occurred on all days of survey. The record identified a diagnosis, dated 07/20/22, of nicotine dependence with withdrawal. An annual Minimum Data Set (MDS), dated…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review, and staff interview, the facility failed to provide food in a form to meet individual needs for 1 of 1 sampled resident with an order for ground meat (Resident #76). Failure to provide ground meat as ordered may result in reduced intakes and chewing/swallowing difficulties. Findings include: Review of Resident #76's medical record occurred on all days of survey. A physician's order, dated 08/29/23, stated, Regular diet, Regular texture, Thin consistency, Ground Meat. The resident's care plan also identified a regular diet with ground meat. Observation on 09/05/23 at 5:55 p.m. showed Resident #76 eating dinner in the dining room. Staff served the resident whole sausage links which were not chopped/ground. Observation on 09/06/23 at 5:47 p.m. showed Resident #76 eating dinner in the dining room. Staff served the resident a hamburger on a bun which was not chopped/ground. During an interview on the afternoon of 09/07/23, an administrative nurse (#1) identified Resident #76 is to have ground meats related to poor dentition.

Based on observation, facility policy, and staff interview, the facility failed to serve, prepare, and store food in a safe and sanitary manner for 1 of 1 kitchen. Failure to label and date food with the expiration date, discard expired food, and ensure dishware and food is free from dust/debris increased the risk for contamination and has the potential to result in foodborne illness to residents, staff, and visitors. Findings include: Review of the facility policy titled Dietary Services occurred on 09/06/23. This undated policy stated, . food/leftovers must be dated, labeled, covered . toxic cleaning materials must be stored and used in such a manner as not to contaminate food . stored in a separate room . Observationsof the kitchen occurred on 09/05/23 at 1:54 p.m. and showed the following: - One package of turkey and ham with an expiration date of 8/24/23. - One undated package of cooked chicken. - One undated, unlabeled, and uncovered container of a custard dessert. - One undated and uncovered container of pudding. - One undated container of cooked carrots. - One undated open…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation and review of facility policy, the facility failed to follow standards of infection control for 2 of 7 sampled residents (Resident #6 and #14) observed while receiving toileting assistance. Failure to follow infection control practices regarding hand hygiene during cares has the potential for transmission of communicable diseases and infections to residents, staff, and visitors. Findings include: Review of the facility policy titled Infection Control - Hand Hygiene occurred on 09/07/23. This policy, dated July 2023, stated, . The Centers for Medicare and Medicaid State Operations Manual indicates that hand hygiene should be performed . Before and after assisting a resident with personal cares . before and after assisting a resident with toileting . after removing gloves . The use of gloves does not replace handwashing/hand hygiene. - Observation on 09/05/23 at 3:37 p.m. showed a certified nurse aide (CNA) (#3) assist Resident #14 with toileting. Resident #14 placed her left hand on the toilet riser to lower herself onto and off the toilet. The CNA (#3) provided…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.